Vinod Khosla: Machines will replace 80 percent of doctors

Machines will replace 80 percent of doctors in a healthcare future that will be driven by entrepreneurs, not medical professionals, according to Sun Microsystems co-founder Vinod Khosla.

Khosla, who wrote an article entitled Do We Need Doctors Or Algorithms? earlier this year, made the controversial remarks at the Health Innovation Summit in San Francisco, hosted by seed accelerator Rock Health. The article had already touched on some of the points of his keynote speech, however it was at the summit that the investor challenged a room full of doctors to disagree with his argument -- a challenge that was met with silence. Either the collection of professionals -- that included fellow speakers Andy Grove, Intel's former CEO, and Thomas Goetz, executive editor of Wired US -- were too horrified by a future where patient care is sacrificed for efficiency, or maybe, just maybe, they realised Khosla was speaking a lot of sense and that the healthcare system in its current state will, one day soon, be rendered redundant.

With no qualms about offending an auditorium filled with practicing doctors, Khosla went on to refer to common medical practice as being akin to voodoo, saying "healthcare is like witchcraft and just based on tradition" rather than data driven, as he believes it should be. Machine learning, he argues, will be a more efficient, cheaper and more accurate diagnosis tool one day, leading to a replacement of 80 percent of doctors (those in the upper 20th percentile can remain, apparently). At one point, he even compares medical diagnosis to Google's driverless smart car technology, saying that the latter is more difficult to develop than an accurate diagnostics machine.

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If that wasn't enough to ruffle a few feathers, he continued by explaining that the major healthcare disruption he is envisaging does not need to be led from within, but may even be more successful if driven from without. Citing Jack Dorsey's Square -- where the vast majority of employees working to disrupt the typical electronic payment system have never worked in the industry before -- he argues that success could viably come from technology entrepreneurs focused on consumer-targeted innovations.

Khosla has had a vested interest in healthcare for some time, having already invested in projects like AliveCor, an iPhone heart monitor attachment that he funded via Khosla Ventures. The investment firm has also poured £600,000 into the development of Cellscope, an app that transforms the smartphone into a microscope used to test for ear infections. With these tools, he is helping the industry edge towards a system that is consumer driven and competitive, where patients have more control and understanding of their own health, thus giving them more space to make informed choices about their treatment. At least this is the goal in the long term, and it's a trend we have been seeing for some time, with even the NHS stepping up and crowdsourcing consumer-friendly heathcare apps. For now, plenty of professionals have already spoken out against Khosla's dramatic proposal. However most of their contentions are based on the less than flattering view of the medical profession he is portraying that says their assistance might be superfluous in transforming the industry. "Does innovation mean the two guys in a garage who come up with a radical idea or is it possible that innovation is having people with different experiences and points of view looking at the same problem," counters Davis Liu, a US-based GP and author, in his excellent summary of Khosla's speech. "Surely to make healthcare better, technology entrepreneurs must engage with doctors."

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Liu does concede that Khosla's critique of the healthcare system is valid, saying, "Can we do better in being more reliable, consistent, and creating a system process and design that is comparable to highly reliable organisations and industries? Of course. Can we be more systematic in doing the right thing for every patient every time on areas where the science is known to the level of the molecule? Yes. Care must be incredibly simple-to-access, extremely convenient and intensely personal". Simple-to-access and extremely convenient are two things certainly reflected in Khosla's view of the future -- intensely personal, however, is where his vision might be contested by many in the industry. The business of healthcare is typified by long waiting lists and a balancing act of cost versus likely positive outcome, but neither of these things are consumer-friendly. It's no wonder it is seen as a failing business, with record losses and an unsatisfied consumer base. Machine efficiency seems like a likely and beneficial solution, but what would it mean losing? "There are some things that may never be codified or driven into algorthims," argues Liu. "Call it a doctor's experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of healthcare is bright after all... I know healthcare can't simply be solved by smart people in Silicon Valley alone. To solve healthcare we need everyone to collaborate." "Domain expertise is often critically required, first to deeply understand the problem at hand and then to come up with an implementable solution," agrees David Shaywitz. "Trained as a physician, and working in the medical products industry, it's perhaps not surprising I view deep experience in healthcare and the complexity of the healthcare system as enormously enabling. While Khosla worries healthcare domain expertise may stifle innovation, I see this type of experience as essential, providing the needed foundation for understanding problems and developing workable and relevant solutions. "There's no doubt that Khosla is a bold, imaginative, and creative sort of person. But all the same, I'd feel a lot better to see additional investors with deeper healthcare experience and a different set of beliefs get into the game, and take a stand as well."

For Liu, the collaboration could revolutionise areas where modern medicine has stalled -- "more illnesses are understood, specific medications and treatment protocols can be designed, but we haven't solved it all. When we thought we knew it all, we were shown how little we truly knew". However it should be seen as complimentary and collaborative, not a total replacement and fix.

Shaywitz says that technology investors "with cash to spare", such as Khosla, have an open field "to explore a phenomenally promising, but also tremendously uncertain and unproven space" because healthcare venture capital firms are growing increasingly sidelined.

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Whatever a physician's stance, few would argue that US and UK healthcare systems in their current states are proficient enough.

With leaps being made in medical technology, and remote diagnosis becoming increasingly invested in (iRobot has created a telepresence doctor's assistance and even the European Space Agency is developing an augmented reality headset to kit astronauts out with the skills of a surgeon) the system needs to keep up to reflect this, and Khosla is unrelentingly going to encourage a healthy debate and, more importantly, a call to action.